Social vulnerability and medical complexity among medicare beneficiaries receiving home health without prior hospitalization

Abstract

Background and Objectives: Recent Medicare home health payment changes reduce reimbursement for care provided to patients without a preceding hospitalization. Beneficiaries may enter home health without a preceding hospitalization via referral from a community provider or through incurring multiple episodes of home health care. We assess potential implications of this change by examining the characteristics of patients accessing Medicare home health through each of these pathways. Research Design and Methods: Nationally representative retrospective cohort study of 1,224 (weighted n = 5,913,080) older adults who participated in the National Health and Aging Trends Study between 2011 and 2015 and received Medicare-funded home health within 1 year of interview. Patient characteristics before home health were drawn from the National Health and Aging Trends Study, while characteristics during home health, referral source, and number of episodes incurred were drawn from linked Outcomes and Assessment Information Set and Medicare claims. We tested for differences in characteristics by referral source and number of episodes using weighted chi-square tests and t tests. Results: Patients referred to home health from the community were more than twice as likely to be Medicaid-enrolled (24.0% vs 12.5%, p